{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YERBUADROFLUF M","gend":0,"add":"OSREFFEJ 199513 TOL EVA N","city":"NEWPORT NEWS","state":"VA","zip":"23605-9998","dob":"1941-06-13","age":"","mstatus":"","insh":"57200210*98","cliId":"","pno":"08\/7579956-6","cno":"","email":"","ename":"","eno":"","pphy":"WEISMAN, TODD A MD","ppno":"757\/726-5000","pcpadd":"200 EATON ST","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23669,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Old Hampton","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I49.5","Z95.0","I48.92","N17.9","D64.9","I44.7","Z95.1","R73.9","G24.9","E78.5","I25.2","I25.10","I12.9","N18.9","K21.9","N39.41","N40.1","Z79.82","Z79.899","I47.1","I10.","I49.9","R97.20","N28.9","R00.0","Z95.811","I48.91","N40.0","Z79.01","Z88.8","Z86.010","Z82.49","Z83.3","Z82.3","R00.2","I25.118","I45.9","R53.81","R53.83","Z12.11","I25.810","M62.838"],"date":["2021-08-27","2021-08-27","2019-10-04","2019-05-03","2019-05-03","2019-09-23","2019-09-16","2019-05-03","2019-05-03","2019-09-16","2019-09-16","2019-09-26","2019-05-03","2019-05-03","2019-05-03","2019-05-03","2019-05-03","2019-09-16","2019-09-16","2019-09-27","2019-09-26","2019-09-26","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2019-10-04","2019-05-03","2019-05-03","2019-05-03","2019-05-03","2019-05-24","2019-09-23","2019-09-23"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","METOPROL"," METOPROL ","30","Select","Select",""],["","61314030802","AZELASTINE","DRO 0.0005","6","Select","Select",""],["","","DIAZEPAM"," DIAZEPAM ","60","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","30","Select","Select",""],["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","","ELIQUIS"," ELIQUIS ","60","Select","Select",""],["","","MULTAQ"," MULTAQ ","60","Select","Select",""],["","","XARELTO"," XARELTO ","60","Select","Select",""],["","","AMIODARONE"," AMIODARONE ","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}